Tom Price, Veema Serma Pitch Conservative Medicaid Changes

Letter asks governors to climb aboard

Department of Health and Human Services Secretary Dr. Tom Price and newly confirmed Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma have lost no time in making it clear that they want to give states greater flexibility to redesign their respective Medicaid programs, according to a report from FierceHealthcare. The changes could pave the way for more-conservative policies such as work requirements and premium contributions.

Price and Verma recently sent a letter to the states’ governors laying out their health care vision. “Today, we commit to ushering in a new era for the federal and state Medicaid partnership where states have more freedom to design programs that meet the spectrum of diverse needs of their Medicaid population,” they wrote.

In particular, they mentioned the expansion of Medicaid through the Patient Protection and Affordable Care Act to nondisabled, working-age adults without dependent children, which they saw as “a clear departure from the core, historical mission of the program.”

The letter lists five key areas where Price and Verma intend to improve collaboration with states:

  • Improve Federal and State Program Management

As part of this initiative, Price and Verma said their agencies will aim to fast-track the approval of waiver and demonstration project extensions. They will also be “more consistent” in evaluating and incorporating state applications for waivers or demonstrations that have been approved in other states.

  • Increase Employment and Community Engagement

Price and Verma affirmed CMS support for federal, state, and local programs that have been successful in helping eligible low-income adult beneficiaries improve their economic standing. “The best way to improve the long-term health of low-income Americans is to empower them with skills and employment,” they wrote.

  • Align Medicaid and Private Insurance Policies for Nondisabled Adults

States may also consider aligning Medicaid’s design and benefit structure with common features of commercial health insurance, Price and Verma suggested. These state-led reforms could include alternative benefit plan designs and cost-sharing models; facilitating enrollment in employer-sponsored health insurance options; “reasonable, enforceable” premium or contribution requirements; waivers of nonemergency transportation benefit requirements; and expanded options to design emergency-room copayments to encourage the use of primary and other nonemergency providers for nonemergency medical care.

  • Provide Timelines and Processes for the Transformation of Home and Community-Based Services

Price and Verma’s letter assures governors that their states will be given additional time to comply with the January 2014 Home and Community-Based Services (HCBS) rule, which defines a home and community-based setting.

  • Provide States With More Tools to Address the Opioid-Abuse Epidemic

Price and Verma also promised that their agencies will ensure that states have the tools they need to combat the current opioid epidemic and that they will continue to explore additional ways for states to provide “a full continuum of care” for people with addiction.

Sources: Office of the Secretary of Health and Human Services; March 15, 2017; and FierceHealthcare; March 15, 2017.